A huge cultural shift is needed in the NHS in England to ensure children get the right care, a government-commissioned review says.

The report, by Professor Sir Ian Kennedy, who used to lead the NHS regulator, said services were mediocre.

He called for specialist training for GPs and extra investment in services.

Particular attention also needed to be paid to transferring children into adult services between the ages of 16 and 18, Sir Ian said.

The review was commissioned following the case of Baby P.

The toddler - subsequently named as Peter - had been seen by health services on 35 occasions by the time he died in 2007, aged 17 months and after suffering more than 50 separate injuries.

This included appointments with GPs, health visitors and paediatricians as well as being seen at walk-in centres.

Catalogue of abuse

The catalogue of abuse he suffered emerged during a court hearing in 2008 that led to the conviction of his mother, her boyfriend and their lodger for causing his death.

This review was ordered last autumn by the then Health Secretary, Andy Burnham.

Sir Ian said there were a large number of areas that needed significant improvement.

He said most GPs had not had paediatric training and therefore A&E had become the "default option" for parents with ill children.

He also complained about the lack of coordination and information sharing between different parts of the health service.

One parent told the review that in the 18 years of caring for a disabled child she had never once been seen by more than one consultant despite being under orthopaedic, neurological, spinal and general paediatric teams.

These myriad systems can make life impossible for the children, young people and their families who desperately need the services that the NHS exists to provideSir Ian Kennedy, Head of review

Investment was also highlighted as a problem. The NHS budget stands at £110bn, but the government estimates just £6.7bn of the figure goes on children and young people.

The report highlighted one case where a child was released from hospital, but despite needing a £2.50 plastic feeding tube, there was a dispute over whether this would be funded.

The NHS and social care teams responsible then accrued costs of £20,000 before an out-of-court settlement.

Sir Ian concluded there were too "many barriers" hampering care which had left a "sea of mediocrity".

"These myriad systems can make life impossible for the children, young people and their families who desperately need the services that the NHS exists to provide."

Health Secretary Andrew Lansley said the findings laid bare the "true scale" of the problems, which he said he was determined to address.

He also published a detailed document setting out how he wanted services to change under his proposals to set up GP consortiums to take control of the NHS budget.

This included better monitoring of the results of care, more choice and more involvement in the design of services.

The Royal College of Paediatrics and Child Health said: "This is a crucial document for the future health of children and is particularly important given that the recent government health white paper has little to say about children."

Sir Ian's review is not the first time NHS procedures have been reviewed. Last year the Care Quality Commission carried out a review of child protection procedures following the Baby P case.

It concluded the NHS risked missing another abuse scandal because of gaps in child protection. It identified a lack of training, poor monitoring and high workloads.

That review came after the regulator had already looked at the role of the NHS organisations that came into contact with Baby P, saying they missed valuable opportunities to save his life.